Symptomatic snapping knee from biceps femoris tendon subluxation: an unusual case of lateral pain in a marathon runner

Snapping biceps femoris syndrome is an uncommon cause of lateral knee pain and may be difficult to diagnose, resulting in unsuccessful surgical intervention. In this report, we present an unusual case of a 37-year-old male marathon runner with unilateral snapping knee secondary to dislocation of the long head of the biceps femoris over the fibular head during knee flexion. The pain was great enough to interfere with his ability to practice sport. Possible causes of symptomatic snapping knee include multiple intra-articular or extra-articular pathology. Biceps femoris snapping over the fibular head is a rare condition. Reported causes include an anomalous insertion of the tendon into the tibia, trauma, and fibular-head abnormality. However, none of those conditions accounted for his symptoms. Failing conservative treatment, the patient underwent surgery for partial resection of the fibular head, with subsequent sudden resolution of symptoms and return to sport. Accurate knowledge and management of this rare condition is mandatory to avoid inappropriate therapy and unnecessary surgical procedures

Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema

<p>Abstract</p> <p>Background</p> <p>Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices.</p> <p>Methods</p> <p>Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics.</p> <p>Results</p> <p>Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking.</p> <p>Conclusions</p> <p>The results confirm and quantify the causal relationships with smoking.</p

The Timing of Daily Demand for Goods and Services – Multivariate Probit Estimates and Microsimulation Results for an Aged Population with German Time Use Diary Data

Though consumption research provides a broad spectrum of theoretical and empirical founded results, studies based on a daily focus are missing. Knowledge about the individual timing of daily demand for goods and services, opens – beyond a genuine contribution to consumption research – interesting societal and macro economic as well as individual personal and firm perspectives: it is important for an efficient timely coordination of supply and demand in the timing perspective as well as for a targeted economic, social and societal policy for a better support of the every day coordination of life. Last not least, the individual daily public and private living situations will be visible, which are of particular importance for the social togetherness in family and society. Our study contributes to the timing of daily consumption for goods and services with an empirical founded microanalysis on the basis of more than 37.000 individual time use diaries of the nationwide Time Budget Survey of the German Federal Statistical Office 2001/02. We describe the individual timing of daily demand for goods and services for important socio-demographic groups like for women and men, the economic situation with income poverty and daily working hour arrangements. The multivariate microeconometric explanation of the daily demand for goods and services is based on a latent utility maximizing approach over a day. We estimate an eight equation Multivariate/Simultaneous Probit Model, which allows the decision for multiple consumption activities in more than one time period a day. The estimates quantify effects on the timing of daily demand by individual socio-economic variables, which encompasses, personal, household, regional characteristics as well as daily working hour arrangements within a flexible labour market. The question about individual effects of an aged society on the timing of daily demand for goods and services is analyzed with our microsimulation model ServSim and a population forecast for 2020 by the German Federal Statistical Office. Main result: There are significant differences in explaining the timing of daily demand for goods compared to services on the one hand and in particular for different daily time periods. The conclusion: without the timing aspects an important and significant dimension for understanding individual consumption behaviour and their impacts on other individual living conditions would be missing